Incremental value of combinatorial contrast echocardiography and 18F-fluorodeoxyglucose positron emission tomography/computed tomography in giant right atrial myxomas

Although several studies have shown that myocardial contrast echocardiography and 18-FDG PET/CT can differentiate between benign and malignant intracardiac masses, it is rarely used in practice to evaluate myxoma. This case describes the contrast echocardiography and 18-FDG PET/CT findings of a giant myxoma with an atypical location and subclinical symptoms.

Fire at the gate ruins fish: pulmonary embolism caused by right atrial myxoma

Myxoma is the most common benign type of cardiac tumour. Myxomas mainly occur in the left atrium, rarely in the right atrium. Right atrial myxoma (RAM) is therefore associated with few cases of pulmonary embolism (PE). In this study, we explored a case of RAM associated with PE and characterised by loss of consciousness. The patient was treated by surgical excision of the RAM. After the surgery, the patient showed a good recovery and was discharged nine days after the operation.

[Minimally Invasive Cardiac Surgery for a Left Atrial Myxoma with Atrial Septal Defect:Report of a Case]

A 48-year-old woman presented with abnormal electrocardiogram was diagnosed as having a left atrial tumor by echocardiography. She was asymptomatic and had no history of cardiac abnormality. Transthoracic echocardiography revealed a relatively hyperechoic and heterogenous tumor with the diameter of 5~6 cm originated from the left atrial septum but could not detect atrial septal defect. Transesophageal echocardiography showed atrial septal defect of fossa ovalis but failed to uncover shunt flow behind the tumor. We diagnosed as left atrial myxoma complicated with atrial septal defect, and an operation was performed through small right intercostal thoracotomy. The tumor was excised and the atrial septal defect was completely repaired after pulmonary vein isolation. The post-operative course was uneventful. Cardiac myxoma coexisting atrial septal defect is rare, and preoperative transesophageal echocardiography is considered essential for the diagnosis of coexistent lesions especially in the patients minimally invasive cardiac surgery is planned.was uneventful. Cardiac myxoma coexisting atrial septal defect is rare, and preoperative transesophageal echocardiography is considered essential for the diagnosis of coexistent lesions especially in the patients minimally invasive cardiac surgery is planned.

Cardiac myxoma presenting with multisystem involvement

A cardiac myxoma is a rare tumor that could be incidental or present with common symptoms due to embolization. A minority of cases are attributed to carney complex, a rare inherited disease. A 73-year-old Asian male presented with acute left-side weakness, slurred speech, gait imbalance, and subacute constitutional symptoms. Left atrial myxoma was discovered by computed tomography and confirmed by echocardiography. Brain imaging revealed pituitary macroadenoma with subarachnoid and intraventricular hemorrages. The hormonal profile confirmed pituitary apoplexy, for which hormone replacement was initiated. Workup also revealed multiple endocrine tumors and excluded infection and malignancy. Myxoma resection could not be carried out, due to the patient's rapid clinical deterioration and death.Furthermore, the presence of cardiac myxoma, non-functioning pituitary macroadenomas, and pituitary apoplexy is extremely rare and rarely documented in the literature. Therefore, we emphasize clinical awareness of rare conditions with atypical presentations to improve outcomes.

INTRAMUSCULAR MYXOMA OF THE BUTTOCK- A CASE REPORT

Intramuscular myxoma (IM) is a benign, soft tissue neoplasm of mesenchymal origin. IM is rare, with an incidence of between 0.1 and 0.13 in every 100,000 individuals. Onset is usually between the fourth and seventh decades of life, predominantly in women (70%). The thigh is the common site of involvement seen in 51% patients, followed by upper arm (9%), calf (7%), and rarely in buttocks. We present the case of a 63-year-old female patient with a 6-month history of a growing IM of the right buttock. Due to rapid tumor growth resection of the tumor was indicated to obtain histopathological examination and to rule out malignancy. Marginal surgical removal was performed. Histopathological examination brought the diagnosis of a big intramuscular myxoma. There is no recurrence at latest follow-up.

[Cardiac masses: classification, clinical features and diagnostic approach]

The term cardiac mass refers to benign or malignant cardiac tumors and cardiac metastases but also to pseudotumors, which is a heterogeneous group consisting of thrombi, vegetations and normal variant structures. While primitive cardiac tumors are rare, metastases and pseudotumors are relatively common. The non-invasive diagnostic approach has not been well established in the literature yet. The first-line non-invasive approach consists of echocardiography, which provides good diagnostic accuracy for masses like thrombi, vegetations and some tumors (mainly myxoma and fibroelastoma). In contrast, for other masses, it does not provide information about the potential malignancy because of poor tissue characterization. Second-line (cardiac computed tomography and cardiac magnetic resonance) or third-line (positron emission tomography-computed tomography) evaluations have been validated in the diagnostic approach to cardiac masses by many studies. In fact, a comprehensive diagnostic approach may establish the diagnosis of malignancy without histological report, which is pivotal for the subsequent therapeutic strategy.The aim of this narrative review is to describe the commonly available non-invasive diagnostic techniques for cardiac masses, their potential and limitations and to suggest a diagnostic pathway for common practice.

Aggressive angiomyxoma of the stomach: a novel site of a rare neoplasm

Aggressive angiomyxoma (AA) is a rare neoplasm of mesenchymal origin. It most commonly occurs in young women, predominantly in the pelvi-perineal region. We describe a case of AA arising from the lesser curvature of the stomach in a young woman who presented with a lump in the abdomen for 6 months. The patient subsequently underwent en bloc resection of the tumour and the diagnosis was confirmed on histology. This is the first reported case of gastric origin of AA to the best of our knowledge.

Cardiac myxoma: benign, but deadly disease

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Massive atrial myxoma presenting with unexplained haemoptysis

Cardiac myxomas are scarce and their clinical manifestations can often be misdiagnosed or confused with other medical conditions. However, early diagnosis and surgical resection can prevent devastating complications of myxomas.We herein describe a case of a huge left atrial myxoma of a female patient in her late 30s. What makes our case unique, apart from the massive size of the myxoma, is the unusual clinical presentation with incessant cough and haemoptysis for more than 6 months. The diagnosis was made by echocardiography and cardiac MR and successful surgical resection was performed with good long-term outcome.

Mineralized, obstructive cardiac myxoma with chondroid differentiation in a cocker spaniel

A 12-year-old castrated male cocker spaniel dog was referred for evaluation of signs consistent with right-sided heart failure. Thoracic radiography revealed mineralization in the region of the right atrium. Echocardiography identified a mass partially filling the right atrium and right ventricle and obstructing flow through the right heart. These findings were confirmed at necropsy and histopathologic features were consistent with myxoma with chondroid differentiation.

[Surgery for a Massive Left Atrial Myxoma, Four Hours after a Thrombectomy for a Cerebral Embolism:Report of a Case]

A 48-year-old female patient was transferred with dysarthria and left-sided hemiplegia. Contrast-enhanced computed tomography revealed occlusion of the first branch of the right middle cerebral artery, for which an emergency thrombectomy was successfully performed within 2 hours of patient's initial symptoms. Postoperatively, transthoracic echocardiography revealed a massive mobile left atrial mass, measuring approximately 65×30 mm, a part of which moved in and out of the mitral valve without significant mitral regurgitation. Embolisms to the kidneys and the spleen were demonstrated. Another emergency cardiac surgery was performed, 4 hours after the thrombectomy, to resect the mass from the fossa oval with the atrial septum;the defect was closed using autologous pericardium. The histopathological findings of the specimen were consistent with a myxoma. The patient completely recovered and was discharged when ambulatory. We have discussed the importance of the timing of surgical intervention in the context of patients undergoing cardiac surgery after a cerebral embolism.

Left Atrial Appendage Mass in a Patient with COVID-19: Identification and Operative Management

Atrial myxoma is the most common primary left atrial tumor. Here we present a case report of a COVID-19 positive patient who was found to have an incidental left atrial appendage mass, concerning for thrombus. Further workup of the mass was suspicious for myxoma, warranting surgical resection.

A study of 399 cardiac tumors: Characteristics of echocardiography and pathological features

AIMS

This study aimed to summarize the transthoracic echocardiography (TTE) characteristics of cardiac tumors with different pathologies.

METHODS

The data of 399 patients with cardiac tumors confirmed by pathology, who had undergone surgical resection were consecutively collected in our hospital between January 1, 2011 and December 31, 2019. The TTE characteristics were summarized and compared with the pathology.

RESULTS

Mean patient age was 49.8±15.7 years (22 children and 377 adults), and 62.2% were female. Of the tumors, 90.5% (361) were primary and 9.5% (38) were secondary. Further, 88.7% (354) were benign and 11.3% (45) were malignant. Of the primary tumors (96.1% benign and 3.9% malignant), 84.2% were myxomas, followed by 3.5% lipomas and 1.5% fibromas in adults, while in children, 31.8% were rhabdomyomas and 22.7% were fibromas. The most common type of secondary cardiac tumor was malignant liver carcinoma metastasis (39.5%) and benign intravenous leiomyomatosis with cardiac extension from the uterus (18.4%). TTE features of myxoma showed four variation types among 8.9% of myxomas: liquefaction (anechoic region mostly), calcification (hyperechoic range with a shadow), multiple nodules, and high proliferative activity (a large irregular mass with a wide base and a high Ki67 index). The TTE characteristics of some common benign non-myxoma tumors had specific findings. The TTE features of malignant tumors mostly showed hypoechogenicity, an unclear boundary, a wide basement, and multi-chambers or tissue invasion.

CONCLUSIONS

Most cardiac tumors have typical ultrasonic manifestations. Preoperative echocardiography could roughly judge cardiac tumor type and may be helpful for guiding clinical treatment decisions.

[Left Atrial Myxoma with Coronary Artery-left Atrial Fistula:Report of a Case]

A 76-year-old woman underwent screening echocardiography. A cardiac mass was detected in the left atrium. It was located at the atrial septum, and was around 3 cm in size. Its surface was smooth and there was cystic cavity inside. Coronary angiography revealed rich blood flow from bilateral coronary arteries to the mass and massive shunt to the left atrium, which formed a fistulous connection. We performed tumor resection under cardiopulmonary bypass. Postoperative course was uneventful. Histopathologically, the tumor was myxoma. Cardiac myxoma is the most common primary cardiac tumor, but myxoma exhibiting coronary artery-left atrial fistula is fairly uncommon.

[Concomitant Tricuspid Annuloplasty with Resection of a Giant Right Atrial Myxoma:Report of a Case]

Myxomas account for the vast majority of heart tumors in adults. About 70% originate in the left atrium, while about 10% of these are reported to originate in the right atrium. A 70-year-old man with dyspnea, was found to have a giant right atrial mass by echocardiography, and tumor resection was performed under cardiopulmonary bypass( CPB) through a median sternotomy. At weaning from CPB the patient was hemodynamically unstable. Intraoperative echocardiography showed severe tricuspid regurgitation( TR), and tricuspid annuloplasty was performed. The postoperative course was uneventful and histopathological examination confirmed that the tumor was a myxoma. It is important to keep in mind that regurgitation of the atrio-ventricular valve might occur after resection of atrial myxoma.

Vulvar aggressive angiomyxoma: a surgical challenge

Aggressive angiomyxoma is a rare and locally aggressive mesenchymal tumour, predominantly occurring in women of reproductive age group. The term aggressive is attributed to the infiltrative nature and frequent local recurrences. They arise commonly from the vulvovaginal region, perineum or pelvis and are usually misdiagnosed as other common entities in these regions. Radiological investigations aid in the diagnosis and planning of surgery. However, the final diagnosis in most of the cases is established by histopathological examination. We herein report a case of a middle-aged woman presenting with recurrent large right vulvar mass highlighting the surgical challenges posed by its intrapelvic extension.

[Resection of a Myxoma Orginating from the Coumadin Ridge with Superior Transseptal Approach:Report of a Case]

A 70-year-old man with a history of lacunar stroke about a year before was incidentally found to have primary cardiac tumor during the work up for orthopedic surgery. It uniquely originated from the coumadin ridge between the left upper pulmonary vein and the left atrial appendage. He underwent tumor resection under cardiopulmonary bypass with superior transseptal approach. It allowed enough surgical exposure for en-bloc resection of the tumor with minimal risk of tumor embolisms. The pathological report confirmed that the tumor was a cardiac myxoma. The postoperative course was uneventful with no stroke nor embolism complications. We experienced a rare myxoma orginating from the coumadin ridge and successfully resected it with superior septal approach.

[Odontogenic myxoma in children : an exceptional locally aggressive lesion]

Odontogenic myxoma is a histologically benign and aggressive tumour of the maxillofacial region. It mainly affects young adults and remains exceptional in children. Due to its local invasive nature, it is difficult to differentiate this tumour from malignant neoplasma and from other destructive odontogenic benign tumours. Imaging plays an essential role in the initial exploration and follow-up. Its management is still a challenge today, due to its aggressive potential and its significant risk of recurrence in children among whom extensive surgical treatment involves significant morbidity in children.

RIGHT VENTRICULAR MYXOMA IN AN ASYMPTOMATIC PATIENT

Myxomas are the most common cardiac tumors; however right ventricular myxomas are very rare. We present the case of an asymptomatic 74 year old female with a right ventricular myxoma originating from the interventricular septum diagnosed during a routine echocardiographic examination. Initially the patient refused surgery due to being asymptomatic, but agreed to be operated two months later. Surgical removal was uneventful, as was the postoperative course. Histopathological analysis confirmed the suspected diagnosis of cardiac myxoma.

Rare presentation of atrial myxoma: chest pain, dysphagia and left upper extremity weakness

Atrial myxoma is a benign primary heart tumour, which can be found incidentally on imaging studies. It is usually located in the left atrium and may manifest as dyspnoea, chest pain, heart failure, cough, shortness of breath when rising from a recumbent position, haemoptysis, hoarseness and as a source of cardiac embolism. However, dysphagia caused by an atrial myxoma has been reported only twice in the literature. We present a 53-year-old Caucasian man with a chronic history of dysphagia caused by an atrial myxoma, in which surgical resection resulted in complete resolution of his dysphagia.